ABSTRACT
There are numerous examples in surgical history of how technical advances have allowed complex malformations that once needed multiple procedures to be repaired in a single operation. Primary (often staged) closure of the bilateral cleft lip and secondary correction of the nasal deformity have been largely abandoned. The modern strategy is simultaneous correction of the double labial clefts, alveolar gaps, and nasal deformity, followed by repair of the secondary palate. Evolution to synchronous closure of the primary palate occurred because of: (1) dissatisfaction with results of conventional (multistage) operations, (2) improvements in preoperative maxillary orthopedic manipulation, and (3) recognition that the nasal tip and columella can be constructed by anatomic positioning of the alar cartilages and sculpting the investing skin. Although the principles of single-stage repair of bilateral cleft nasolabial deformity are established, the techniques to achieve this goal continue to evolve.
